Depressive Symptoms May Be Associated with Diabetes and Dyslipidemia

Depressive symptoms such as low energy have been linked to diabetes, dyslipidemia, and inflammation through hypersomnia and appetite/weight alterations.1

Prior research has highlighted the association between depression and several diseases, including atherosclerotic cardiovascular disease and diabetes. Additionally, a bidirectional association has been noted between depression and cardiometabolic disorder (CMD). Inflammatory and metabolic alterations, along with other mechanisms, may be important in this relationship.1

“The current work extends on former work by incorporating repeated measurements of individual symptoms, markers of inflammation and cardiometabolic syndrome, and disease outcomes in a novel framework of Bayesian network analysis,” Arja Rydin, a PhD candidate in the department of psychiatry at Amsterdam UMC, and colleagues wrote. “Overall, our analytical approach allowed us to not only take into account biological, lifestyle, and psychiatric variables, but also the dimension of time, deepening the understanding of the comorbidity of depression, immune-metabolic dysregulations, and cardiometabolic diseases.”1

Investigators utilized data from the Netherlands Study of Depression and Anxiety (NESDA), an ongoing longitudinal cohort study of depressive and anxiety disorders. NESDA is a naturalistic, multisite, case-control cohort study. The NESDA team conducted an initial baseline face-to-face assessment, followed by planned follow-up data collection waves after 1, 2, 4, 6, and 9 years. The initial assessments lasted 3-4 hours and consisted of self-report questionnaires, a medical examination, cognitive/emotional computer tasks, and biobanking with stored blood sampling.2

In total, investigators included 2981 participants to NESDA – of these, 2329 exhibited a lifetime diagnosis of depressive and/or anxiety disorders, while 652 did not. Mean age at baseline was 41.9 years (standard deviation [SD] 13). However, during the 9-year follow-up, investigators also enrolled 367 siblings from 256 participants with lifetime anxiety and/or depressive disorders, which brought the total participants to 3348. This addition allowed for examination of the family context in the development of depression and anxiety.2

Rydin and colleagues filtered the NESDA data to select 1059 patients with lifetime diagnoses of major depressive disorder (MDD) and a mean age of 42.4 +/- 12.5 years old. Depressive symptoms were highlighted via self-report questionnaires from the Inventory of Depressive Symptomatology. Additionally, the team examined pathophysiological data on metabolic syndrome components and inflammatory markers, as well as CMD.1

Ultimately, the investigators found a chain of energy-related depressive symptoms, namely increases in appetite, weight oscillations, and hypersomnia, connecting to waist circumference and thus diabetes. Waist circumference was noted as most influential on the system, as sensitivity analyses confirmed.1

Investigators noted prior research indicating associations between depression and increased waist circumference. Additionally, increases in abdominal adiposity have been recorded in patients with atypical depression, according to other studies. However, the utilization of a Bayesian network analysis in this particular study allowed investigators to locate directed associations without imposing a direction as a starting point. This, in turn, allows for the measurement of the quantitative importance of variables.1

Rydin and colleagues suggest future research to further investigate these associations. They encourage applying a similar framework to other comorbidities, as well as running a similar analysis with a dataset with CMD cases.1

“Energy-related dysregulations, both regarding depressive symptoms and physiological characteristics, prove to be of importance in this longitudinal approach,” Rydin and colleagues wrote. “Future work should focus on this aspect of depression and provide more mechanistic insights into the MDD-CDD comorbidity. Intervention strategies could benefit by targeting the factor of abdominal adiposity.”1

References

1. Rydin AO, Milaneschi Y, Lamers F, et al. Trajectories of depressive symptoms, metabolic syndrome, inflammation, and cardiometabolic diseases: A longitudinal Bayesian network approach. Brain Behav Immun. 2025;130:106120. doi:10.1016/j.bbi.2025.106120

2. Penninx BWJH, Eikelenboom M, Giltay EJ, et al. Cohort profile of the longitudinal Netherlands study of depression and anxiety (NESDA) on etiology, course and consequences of depressive and anxiety disorders. Journal of Affective Disorders. 2021;287:69-77. doi:10.1016/j.jad.2021.03.026